Sole stenting of large and giant intracranial aneurysms with self-expanding intracranial stents-Limits and complications

Clinical Institute of Diagnostic and Interventional Radiology, University Hospital Center Zagreb, Kispaticeva 12, Zagreb, Croatia.
Acta Neurochirurgica (Impact Factor: 1.77). 05/2010; 152(5):763-9. DOI: 10.1007/s00701-009-0592-y
Source: PubMed


Intracranial aneurysms may be difficult for endovascular treatment due to size, fusiform shape, or wide neck. In such patients, intracranial stents are used to support the coils in the aneurysm sac, or they may be used as a sole stenting technique to divert the blood flow without coils. The aim of this paper is to contribute to the existing data by reviewing the risks of sole stenting of large and giant aneurysms.
We treated seven patients with nine aneurysms by self-expanding intracranial stents, either by a single or multiple stents in a stent-in-stent configuration. The follow-up was performed by digital subtraction angiography with a mean follow-up time of 6 months.
A positive response to stenting occurred in five out of seven patients (71%) and six out of nine aneurysms (67%). The aneurysms were occluded in two patients, and incomplete results were noted in three patients. The symptoms due to the compression of cranial nerves resolved in four patients (57%). Procedure-related subarachnoid hemorrhage occurred in two out of seven patients (29%), with death of one patient as a result of hemorrhage (14%).
Sole stenting of large and giant aneurysms with self-expanding intracranial stents may be associated with a higher risk than previously reported. The effect of stenting on intra-aneurysmal flow in such aneurysms, even after the placement of multiple overlapping stents, seems to be unpredictable.

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    • "In the case of fibromuscular dysplasia, the patient was successfully treated with a Symbiot-type self-expanding stent, without any significant postinterventionnal neurological event.2 As a consequence, endovascular treatment is effective and less invasive,3 although the complication rate of these self-expanding stents can reach up to 10% and the bleeding rate 29%.16 "
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    • "The main issues of stent grafts are their stiffness and the unavoidable occlusion of all covered side branches. The technique of telescoping porous stents may work, but efficiency mostly remains unpredictable [6]. "
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    • "Current endovascular techniques are regarded as having lower risks for the patient [28]. Despite the fact that these techniques are being constantly developed, in GIAs, these still seem to be unsatisfactory in terms of durability of aneurysm occlusion [24, 28]. Parkinson [23] suggests that the results of surgical techniques should be the “gold standard” with which other techniques, including endovascular treatment, are compared. "
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